Download Best Practice in Labour and Delivery by Richard Warren, Sabaratnam Arulkumaran PDF

By Richard Warren, Sabaratnam Arulkumaran

An figuring out of whilst and the way to interfere is the main to sturdy obstetric care. This textbook is an encompassing reference overlaying all of the crucial details with regards to childbirth; it deals transparent functional advice on all elements of labour and supply. Written via famous major specialists, every one bankruptcy bargains a latest authoritative evaluation of top perform. The facts base decribed may help to optimize end result via applicable medical administration and justifiable intervention. while this can be a great textbook for these education and taking examinations in labour ward perform, it bargains all these taking care of the lady in labour a contemporary, evidence-based process so one can support them comprehend, realize and bring the very best scientific care. the significance of group operating, prioritizing, and the association of maternity care obtain applicable emphasis with transparent information and functional suggestion.

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Example text

Effect of regional analgesia on the progress and outcome of labour The recently published NICE Guidelines on Intrapartum Care [12] indicate that epidural analgesia:  is not associated with a longer first stage of labour or an increased risk of a caesarean birth, but  is associated with a longer second stage of labour and an instrumental birth. However, the most important factors determining labour outcome are anaesthetic and obstetric management. Therefore:  low concentrations of local anaesthetics should be used to minimize motor block;  oxytocin should be used to augment labour when required; and Chapter 3: Analgesia and anaesthesia in labour addition of cyclopropane.

A systematic review on the efficacy of N2O was published in 2002 [7]. Seven studies described significant analgesia with N2O and, interestingly, in two studies women continued to use N2O even after the study period was over. Nausea and vomiting was reported as ranging from 5 to 36%. Neonatal Apgar scores were reported in four studies and no differences were shown. Therefore, there is a moderate level of evidence to support the use of N2O in labour, in that N2O is effective for some women with no apparent adverse outcomes for either mother or baby.

Augmentation in the latent phase of labour The duration of the latent phase of labour varies widely and is a period when the diagnosis of labour can be very difficult. Appreciable proportions of women have painful contractions for long periods in the latent phase with little cervical change. The management of the latent phase, once maternal and fetal well-being has been confirmed, consists of explanation, reassurance, hydration, nutrition and ambulation. The mainstay of management of a prolonged latent phase is to avoid unnecessary intervention.

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